Images in cardiology. Continuous murmur through atrial septal defect.
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Aged↗
Biomedical subjects
T Konishi
Publications and source records attributed to T Konishi.
Comparison of anthocyanin distribution in different blueberry sources by capillary zone electrophoresis.
Capillary zone electrophoretic separation of blueberry anthocyanins was studied using a Na-borate buffer containing trans-1,2-diaminocyclohexane-N,N,N',N'-tetra acetic acid monohydrate (CyDTA) as the carrier buffer. The separation conditions were precisely examined using an aqueous extract of bilberry (wild type blueberry) as the separation sample which is rich in this type and amount of anthocyanins. Each separated peak was identified by comparing the mobility with that of anthocyanin standards after normalization against the mobility of malvidin 3-o-glucoside (Mv 3-Glc) added as an internal standard. As salt concentrations of the running buffer increased, the peak resolution was markedly improved over the whole range of separation, especially, among the fast moving components (petunidin 3-glucoside, cyanidin 3-glucoside and malvidin 3-galactoside). Inversely, the peak separation both between petunidin 3-glucoside and peonidin 3-glucoside, and between delphinidin 3-glucoside and petunidin 3-galactoside, respectively, were decreased. The anthocyanins were, however, successfully separated by decreasing the buffer pH. Good separation of anthocyanins was finally achieved by 30 mM Na-borate (pH 8.78) containing 7.5 mM CyDTA within 10 min. Under this separation condition, anthocyanins from different blueberry sources were analyzed. The results revealed that different blueberry sources had their own patterns of anthocyanin distribution and amounts in the extracts, thus the present method is suitable for the quality control of anthocyanin-containing food materials.
Anthocyanins↗
Differentiation-inducing activity of lupeol, a lupane-type triterpene from Chinese dandelion root (Hokouei-kon), on a mouse melanoma cell line.
We examined the differentiation-inducing effects of extracts of 49 wild plants, 25 types of seaweed and 26 mushrooms in Akita on the human leukemia cell line HL60 and a B16 mouse melanoma-derived sub-clone with high differentiation capability (B16 2F2). Differentiation inducers of HL60 cells such as retinoic acid, showed no effects on the differentiation of B16 2F2 cells. Furthermore, chemical compounds known to be inducers of B16 cells, did not induce differentiation of HL60 cells. Screening tests showed that the differentiation of HL60 cells was induced by extracts of 28 wild plants, 10 types of seaweed and 2 mushrooms, and melanogenesis of B16 2F2 cells was increased by extracts of 21 wild plants, 8 types of seaweed and 7 mushrooms. All of the alcoholic extracts of plants belonging to the subfamily Cichorioideae of the family Compositae caused cell differentiation of the melanoma cell line. The extracts of Chinese dandelion root, also inhibited cell growth and induced melanogenesis of B16 2F2 cells. We isolated the active compound from ethanol extracts of the crude drug. Chemical and physical data for the active compound were identical with those for lupeol, a lupane-type triterpene.
Animals↗
[Basic studies on the utility of ursodeoxycholic acid derivatives for clinical medicine].
The aim of this study was to determine whether the derivatives of ursodeoxycholic acid (UDCA) are useful compounds for clinical medicine. 1-1) A conjugate (5-ASA-UDCA monophosphate) of UDCA monophosphate with 5-aminosalicylic acid (5-ASA) was newly synthesized, and basic studies on this compound were carried out. This compound was efficiently deconjugated by cholylglycine hydrolase (CGH) to release 5-ASA, whereas it was completely resistant to deconjugation by pancreatic and intestinal mucosal enzymes. In animal experiments, the urinary excretion of N-acetyl-5-ASA (Ac-5ASA) was measured for 24 h following the oral administration of 20 mg of 5-ASA-UDCA monophosphate. Control rats excreted 276.3 +/- 89.0 micrograms (mean +/- S.E.) of Ac-5ASA whereas rats with intestinal bacterial overgrowth excreted more (1224.1 +/- 231.5 micrograms; p < 0.01). These basic studies indicate that this compound is likely to offer a simple method for the evaluation of intestinal microorganisms without the use of radioisotopes or expensive, special apparatus. 1-2) The disulphate ester of ursodeoxycholyl-p-aminobenzoic acid (PABA-UDCA) was synthesized and compared with PABA-UDCA for its use in the detection of intestinal bacteria. This compound, PABA-UDCA disulphate, had characters in common with PABA-UDCA in that it was deconjugated by CGH to release free PABA. Further, in rat experiments the urinary excretion of PABA was measured for 6 h after oral administration of 15 mg PABA-UDCA disulphate. Ten control rats excreted 188.2 +/- 13.6 micrograms (mean +/- S.E.) of PABA; 10 rats with an intestinal stagnantloop excreted more (530.1 +/- 30.1 micrograms; p < 0.001): whereas 10 rats in each of three groups pretreated with oral administration of various antibiotics excreted less. PABA-UDCA disulphate is a single pass type substance in the gut and its oral administration test reflects the sum of the activities of bacteria in the small intestine and colon. From the results the obtained PABA-UDCA disulphate was considered a good material to detect intestinal bacteria. 2) A conjugate (Lys-UDCA) of UDCA with L-lysine was newly synthesized. In the incubation experiments with plasma, homogenates of the liver and small intestine, various pancreatic enzymes and CGH, Lys-UDCA was deconjugated by carboxypeptidases B and CGH. In the experiment using rodent everted gut sac, Lys-UDCA was actively absorbed from the terminal ileum. Lys-UDCA was recovered well in the bile after intravenous or intraileal administration of Lys-UDCA in biliary fistula rat. These data suggest that Lys-UDCA is a good prodrug of UDCA for intravenous administration. 3) A novel calcium-chelating agent, N"-ursodeoxycholyl-diethylenetriamine-N,N,N'-triacetic acid (UDCA-DTTA), was synthesized to study its ability to dissolve calcified gallstones. In the presence of the agent, sliced human gallstone with a composition of more than 50% calcium bilirubinate was thoroughly dissolved, indicating that calcium bilirubinate was dissolved from the gallstone. The ability to dissolve calcium was comparable to that of EDTA. However, the laminar structure of the sliced gallstone did not disappear in the presence of EDTA, whereas the structure disappeared in the presence of UDCA-DTTA. These results indicate that UDCA-DTTA is an interesting compound as a parent substance for developing a prodrug for an oral or intravenous agent to dissolve calcium-containing gallstones.
Animals↗
Clinical characteristics of patients with fresh left ventricular thrombus.
The present study analyzed the clinical backgrounds of 9 patients with fresh left ventricular thrombus (LVT) detected by two-dimensional echocardiography during the past 5 years. Patients with acute myocardial infarction were excluded. Left ventricular systolic function was disturbed either diffusely or segmentally in all patients with a mean ejection fraction of 33%. In 7 patients, echocardiography was performed shortly after furosemide therapy for New York Heart Association class IV congestive heart failure; echocardiography was also performed just before treatment in 4 of the 7 patients and LVT was not detected in any of them. Two patients died of underlying disorders within 2 months of detection of the thrombus. However, the LVT disappeared in the other 7 patients without any thromboembolic episodes during the 6 months after starting anticoagulant therapy. As fresh LVT developed shortly after diuretic therapy in patients with severe congestive heart failure associated with left ventricular systolic dysfunction, concomitant anticoagulant therapy is recommended.
Aged↗
Photosensitized reduction of methyl viologen using eosin-Y in presence of a sacrificial electron donor in water-alcohol mixture
Photoreduction of methyl viologen (MV2+) by eosin-Y (EY2-) in the presence of triethanolamine (TEOA) has been investigated in water-methanol mixture by means of steady-state photolysis and laser-flash photolysis in the visible/near-infrared regions. The complete conversion to the persistent methyl viologen radical cation (MV.+) was observed in the presence of lower concentrations of EY2- and excess TEOA. By laser-flash photolysis measurements, electron transfer was confirmed to occur from the triplet state of EY2- [3(EY2-)*] to MV2+ in the rate constants of ca 2.0 x 10(10) M-1 s-1. The rates and efficiencies of production of MV.+ were found to be dependent on solvent compositions and concentrations of MV2+, ionic salt and TEOA. The back electron transfer reaction from MV.+ to EY.- was retarded in the presence of TEOA, which supports that EY2- is reproduced by accepting an electron from TEOA. In the presence of excess TEOA, the indirect formation of MV.+ from EY.3-, which was produced by accepting an electron from TEOA, was confirmed. The contributions of both the oxidative and reductive routes of 3(EY2-)* for the MV.+ formation have been confirmed.
Journal Article↗
Rapidly progressive pneumonia due to Aeromonas hydrophila shortly after near-drowning.
An 87-year-old woman died of rapidly progressive pneumonia due to Aeromonas hydrophila shortly after a near-drowning event. Autopsy showed necrotizing pneumonia and postmortem cultures of both blood and lung revealed the organism. Fulminant pneumonia should be considered in patients of a near-drowning event.
Aeromonas hydrophila↗
The K-ras gene regulates vascular endothelial growth factor gene expression in non-small cell lung cancers.
Tumor angiogenesis is an essential step for tumor cell growth, progression and metastasis. Vascular endothelial growth factor (VEGF) is mitogen specific for endothelial cells, and therefore is believed to play a key role in tumor angiogenesis. However, the mechanisms underlying the regulation of VEGF expression remain virtually unknown and the only major regulator of VEGF expression has been reported to be hypoxia. Recently, it was reported that a mutant p53 in#duced the expression of VEGF mRNA, and that wild-type p53 down-regulated endogenous VEGF mRNA levels. In contrast, it has also been reported that mutant ras oncogenes were associated with the marked up-regulation of VEGF in transformed epithelial cells. Based on these results, we performed a retrospective study of the p53 and K-ras genes status and VEGF gene expression in the tumor tissues from 181 patients with non-small cell lung cancer using SSCP, sequencing, RT-PCR and immunohistochemical techniques. Forty-six carcinomas (25.4%) were evaluated as having high VEGF expression, and 135 tumors (74.6%) had low VEGF expression. Of the 181 primary NSCLC studied, 63 carcinomas (34.8%) contained mutations of p53, whereas only 14 carcinomas (7.7%) had mutations of K-ras. There were no significant relationships between VEGF expression and p53 status or each mutant exon of p53. In contrast, a significant difference was found between VEGF expression and K-ras status. Of the 14 tumors with mutant K-ras genes, 7 cases (50.0%) had high VEGF expression whereas only 39 of the 167 tumors with wild-type K-ras (23.4%) had high VEGF expression (p=0.0278). The mean VEGF conservation rate for the 14 tumors with mutant K-ras genes was 0.77+/-0.58 and the rate of the 167 tumors with wild-type K-ras genes was 0.49+/-0.46 (p=0. 0350). Moreover, the overall survival rate of patients with high VEGF expression was lower than patients with low VEGF expression (45.7% vs 60.7%, p=0.0419). On the other hand, there was no significant difference in the overall survival rate between patients with a mutant p53 and those with a wild-type p53; there was also no difference in the overall survival between patients with a mutant K-ras and those with a wild-type K-ras. The Cox regression model analysis indicated that three variables, VEGF status, K-ras status and nodal status, were found to be significant indicators for prognosis (p=0.0236, p=0.0172 and p<0.0001, respectively). Our data suggest that a high expression of VEGF in lung cancer may be associated with a poor prognosis. This may be a clue to improving lung cancer diagnoses and therapies aimed at inhibiting tumor angiogenesis due to VEGF.
Adult↗
Color flow signal in the left atrium as a mirror image artifact suggesting one leaflet constriction of the St. Jude Medical valve: a case report.
Color Doppler echocardiography detected an abnormal color flow signal originating from the prosthetic mitral valve and extending to the left atrium during diastole in an 84-year-old woman with St. Jude Medical valve replacement. The flow was away from the transducer and almost identical to the left ventricular inflow signal except for the direction. Cinefluoroscopy showed one of the leaflets fixed at systole whereas the other leaflet was mobile. After reinforcement of anticoagulant therapy, this abnormal color flow signal disappeared and motion of both leaflets normalized. This color flow signal, presumably a mirror image artifact of the left ventricular inflow caused by the immobilized leaflet, could be a sign of one leaflet constriction in patients with St. Jude Medical valve replacement.
Aged↗
[Relapse of seizure after withdrawal of antiepileptic drug treatment in childhood epilepsy: age-dependent factors].
In 556 epileptic children, clinical and encephalographic factors concerning the discontinuation of antiepileptic drugs (AED) were studied, with emphasis on age-related factors. Seizures relapsed in 80 patients (14.4%), the incidence being high in idiopathic generalized epilepsy with onsets in adolescence or adulthood (juvenile absence epilepsy, juvenile myoclonic epilepsy, grand mal on awakening), symptomatic partial epilepsy and symptomatic generalized epilepsy. The age distribution at the relapse showed two peaks; 9 to 11 and 17 to 19 years. The first peak represented patients with school-age onset epilepsies, and the second those with the adolescent or adult onset epilepsies. The age at discontinuation of AED depended on each epileptic syndrome, and the relapse rate was significantly higher when the AED was discontinued after adolescence. In 56 patients, seizure relapsed during the withdrawal phase or less than 1 year after the discontinuation. The type of the relapsing seizure was the same as the previous ones. On the other hand, in 16 out of 24 patients whose relapse occurred 1 year or more after the discontinuation, the seizure type was different from the previous ones. These results suggest the relevance of age-dependent factors to the discontinuation of therapy.
Adolescent↗
[Minimal incision cardiac surgery for atrial septal defects].
Minimal incision cardiac surgery for atrial septal defects was performed in 4 consecutive patients. No special devices or new techniques were used to perform this operation. Clamping of the aorta and snaring of the inferior vena cava could be simply omitted from this procedure. A limited(6 to 7 cm) median skin incision was made, followed by a mini-sternotomy from the second intercostal space to right side of the xiphoid process. Through this limited approach, atrial septal defect closure was performed conventionally with a patch under hypothermic circulatory arrest(less than 10 min). The scar was short(5.5 to 7.3 cm) and cosmetically acceptable in all patients. This mini-incisional procedure is a useful option for atrial septal defect closure that can be completed without sophisticated instruments.
Adult↗
[Coronary flow after successful angioplasty in patients with acute myocardial infarction: comparison between coronary flow reserve by nicorandil and papaverine].
In order to evaluate coronary flow response to 2 different vasodilators, nicorandil and papaverine, in patients with myocardial infarction, we measured coronary flow reserve using a Doppler guide wire in infarct-related and non infarct-related arteries. The study group consisted of 28 patients with first acute myocardial infarction 3 weeks after successful coronary angioplasty within 6 hr after symptom onset. Twelve patients with atypical chest pain served as the control group. Coronary flow reserve induced by intracoronary papaverine(12 mg) was lower in infarct-related arteries than in non infarct-related arteries, but there were no differences in coronary flow reserve induced by intracoronary nicorandil(1 mg) between infarct-related and non infarct-related arteries. Coronary flow reserve induced by nicorandil was lower than that by papaverine in non infarct-related arteries and the control group. However, there were no differences between coronary flow reserve induced by nicorandil and papaverine in infarct-related arteries. Vasodilatory response induced by nicorandil was relatively preserved in infarct-related arteries compared with papaverine. These results suggest that impairment of coronary microvascular response in infarct myocardium varies in the different sites acted on by different vasodilator agents.
Angioplasty, Balloon, Coronary↗
[Clinical pathways in oncology].
The diagnosis-related-group/prospective-payment system (DRG/PPS) was introduced into the health care system of the United States in 1983. This system triggered the development and implementation of clinical pathways aimed at reducing the length and cost of hospitalization. In Japan, trial use of a Japanese version of DRG/PPS was initiated in November 1998 in 10 hospitals under the control of the Ministry of Health and Welfare, and full-scale implementation of the system is expected in the near future. Clinical pathways, therefore, are a current focus of attention, mainly because of their success in enhancing management efficiency in the U.S. However, in actual clinical settings where clinical pathways are used, several Japanese health care providers have come to realize that they are also useful in improving staff coordination, patient satisfaction, and patient care, rather than simply reducing the length of hospital stay and cost of health care. The introduction of clinical pathways requires that treatment of the disease in question be defined and standardized. The implementation of pathways for the treatment of cancer, however, might prove difficult because of the high frequency of variation. In our experience, the main reason for the use of clinical pathways is not to reduce the number of variant cases but to provide high-quality care through the promotion of a team approach to treatment and enhanced patient care. Therefore, even if there were frequent variances following surgery for cancer, those occurring in accordance with the pathophysiological state of the patient would not interfere with management by clinical pathways. Clinical pathways are advantageous because they allow patients to know their treatment schedule; to prepare for hospitalization procedures; to have a better perspective on discharge; to reduce anxiety regarding hospital admission, even if it is the first time; to communicate better with doctors, nurses, and other medical care staff, leading to greater trust; and to improve their ability for self-management. These features are all important for the improvement of patient care. Furthermore, clinical pathways may lead to a situation in which the cost of hospitalization can be predicted prior to admission, enabling patients to compare differences between several hospitals. From our experience with gastric cancer, breast cancer, and esophageal cancer management, we consider clinical pathways to be of great benefit in helping to reform the current medical care system in regard to the management of cancer patients as well as patients with other diseases.
Breast Neoplasms↗
[Left ventricular mass in a patient with leukemia].
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Aged↗
[Current trends in surgical treatment of esophageal cancer].
Esophagectomy with cervical, mediastinal and abdominal lymph-node dissection has contributed to the improved survival of patients with esophageal cancer. However, surgery alone cannot provide more satisfactory survival, and new strategies are needed to progress survival. For patients in the advanced stage, combined therapy, such as chemoradiation followed by surgery, is attempted to improve their survival. Three-field lymph node dissection causes a huge surgical stress and it is not necessary for all patients. The optimal fields for lymph-node dissection should be selected according to the depth of the tumor invasion and the location of the primary lesion. Thoracoscopic and/or laparoscopic methods have been adopted over recent years adopted to reduce surgical stress.
Antineoplastic Combined Chemotherapy Protocols↗
[Cost analysis on stomach cancer treatment in Japanese hospitals].
BACKGROUND: In an effort to further the discussion of DRG/PPS, we performed a coat analysis on stomach cancer cases in Japanese hospitals. We analyzed individual in-patient data (both clinical and financial) to research the amount of variation in treatment and costs. METHODS: The data was taken from two hospitals. In order to compare the daily cost/revenue of each episode of operation/hospitalization, we analyzed the data that was stored for reimbursement purposes by using patient ID numbers. We also simulated the cost/revenue in cases where the length of stay could be shortened with clinical pathways created by Japanese hospitals. RESULTS: (1) There is a common pattern for the operation/hospitalization of stomach cancer cases if the patient's condition, like severity, is well controlled. However, there is still a noticeable difference in the length of stay for patients both before and after the operation. (2) Hospitals are currently losing money by having extended patients' lengths of stay. Simulation results indicate that hospitals can reduce losses, even become profitable, by shortening the patient's length of stay. CONCLUSIONS: The potentiality of implementing a standard treatment process and/or a fixed payment system, like DRG/PPS, is high, because there is a common a pattern among the treatment process. More research must be completed in this area, specifically on the significant variations in lengths of stay and the methodology for standardization of treatment. Furthermore, clinical outcomes research must also be done.
Costs and Cost Analysis↗
[Critical paths and economical efficiency on cancer therapy].
The critical paths of cancer patient care are discussed. The number of cancer institutes which have introduced critical paths into patient care has been increasing in the past few years. The effect of critical paths is to standardize the patient care process, shorten the length of the hospital stay of cancer patients, reduce the cost of care, have a well-managed cancer care team, and satisfy patients with full information on the care schedule. Combined with clinical practice guidelines, protocols and algorithms, critical paths are a more powerful tool with which to improve the efficiency and quality of cancer patient management in hospital care.
Algorithms↗